CHAPTER 84
H.P. 1497 - L.D. 2000
Resolve, Directing the Department of Human Services to Apply for a Federal Waiver to Provide Medicaid Benefits to Uninsured Residents with a Diagnosis of Cancer
Sec. 1. Waiver application for Medicaid cancer program. Resolved: That the Department of Human Services shall apply to the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services for a waiver to provide coverage limited to cancer under the Medicaid program. Coverage under a Medicaid cancer program must comply with the following terms.
1. Coverage must be available to a person who has:
A. A confirmed diagnosis of cancer by a qualified physician;
B. A gross family income at or below 250% of the federal poverty level; and
C. No health insurance or no insurance coverage that is adequate for the diagnosis or treatment of cancer.
Age, assets and family status may not be factors in determining eligibility.
2. The department shall adopt rules to implement the program. The rules must contain the following provisions.
A. Coverage is limited to the enrollee and does not include family members.
B. An enrollee must pay minimal copayments.
C. Coverage is limited to the diagnosis and treatment costs for cancer and treatment costs for medical care required as a result of cancer treatment and must last as long as the person is receiving treatment for cancer.
D. Coverage must include the costs for the diagnosis and treatment of cancer that were incurred within 3 months prior to the date of enrollment.
E. For an enrollee who has health coverage, coordination of benefits, subrogation of coverage or redirection of the premium payments must occur in order to decrease costs to the State. Medicaid rules regarding estate recovery apply to Medicaid expenditures incurred under the waiver.
F. Coverage must last as long as the enrollee is a resident of the State, is undergoing treatment and the program is operated by the State.
3. Coverage may not begin under the Medicaid cancer program until the waiver has been obtained from the Centers for Medicare and Medicaid Services and the Legislature has approved the operation of the program and appropriated funding for coverage in the biennial budget.
4. Rules adopted pursuant to this resolve are routine technical rules as defined by the Maine Revised Statutes, Title 5, chapter 375, subchapter II-A.
Effective July 25, 2002, unless otherwise indicated.
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